Doc… I’m drowning!

You are called to triage to assess a man for shortness of breath. Per EMS, this is a 46 year old male with a history of substance abuse and HTN, found by his wife this afternoon, overdosed on Heroin and barely breathing. EMS arrived on scene to find him unconscious, with a RR of 5Read more

SVT not breaking? Try this new yoga pose….

Your 29 year female patient arrives to Resus with a rapid heart rate of 215. Her blood pressure is 129/72. She appears pretty comfortable, however complains of mild shortness of breath and chest pain. She has no cardiac history and no previous history of cardiac arrhythmia. Her EKG from triage demonstrates SVT. As the nursesRead more

Turn down the volume

On your busy resus shift you receive a EMS notification that a post arrest patient is en route, ETA 2 minutes. On arrival the patient is being actively bagged by EMS through an endotracheal tube placed in the field. He is hypotensive to 83/55 and tachy to 112. You confirm ETT placement with direct visualizationRead more

To Hydrate or not to hydrate, that is the question

Is there any data behind renal hydration prior to CT to prevent contrast induced nephropathy? Or is it just a habit we picked up along the way and has no clinical benefit? The AMACING trial answers that question. Prophylactic Hydration to Protect Renal Function from Intravascular Iodinated Contrast material in Patients at High Risk of Contrast-InducedRead more

TXA in the Hemorrhaging Postpartum Patient

On your busy overnight trauma shift at Elmhurst, you are the provider during a precipitous vaginal delivery in the trauma bay at 2am. The infant is delivered without complication, and your Pediatric colleagues give you APGAR’s of 8 and 9. As you call up to L&D, you are told that the staff; attendings and residentsRead more

Rural Pearl- Unprovoked

  Rural Pearl- First time seizure You are back for you solo overnight shift at Rural General Hospital.  At 2 am a new patient comes in with his fiance.  He is a 25 year old male and the fiance says the patient had a “shaking episodes” an hour prior to coming to the hospital.  SheRead more

52 in 52 double dose: San Francisco Syncope Rule

Title: Prospective Validation of the San Francisco Syncope Rule to Predict patients With Serious Outcomes   Article Citation: Quinn, J. et al “Prospective Validation of the San Francisco Syncope Rule to Predict patients With Serious Outcomes” Annals of Emergency Medicine Volume 47, no. 5, May 2006.   What we already know about the topic: SyncopeRead more

52 in 52

The 52 in 52 Review:  The International Registry of Acute Aortic Dissection (IRAD) New Insights Into an Old Disease. Article Citation: Hagan PG et al. The International Registry of Acute Aortic Dissection (IRAD)New Insights Into an Old Disease. JAMA. 2000;283(7):897-903. doi:10.1001/jama.283.7.897 What We Already Know About the Topic:  Aortic dissection has challenged physicians since itRead more

Rural Pearl- Precipitous Delivery

You are once again working your solo overnight shift and Rural General Stand Alone Hospital.  In the door walks a 33 yo G6P5 female with abdominal cramping who is 35 weeks pregnant.  The labor and delivery service recently closed down and all OBGYN is being referred to the regional hospital 45 minutes away.  The patientRead more

Rustic Rural Pearl

You are working at Rural General Hospital, solo coverage overnight     Patient is a 35yo male with no past medical history presents to the ED from home with the complaint of “something in my eye”, he reports blurry vision and severe pain in the right eye.  Visual acuity is grossly intact and his rightRead more